Two years of Finnish Telestroke
Thrombolysis at spokes equal to that at the hub
Abstract
Background:
Official guidelines on stroke promote the use of telemedicine via bidirectional videoconferencing equipment, which provides a valid and reliable means of facilitating thrombolysis delivery to patients in distant or rural hospitals.
Methods:
The present prospective cohort study describes the characteristics and 3-month outcome of the thrombolysis patients treated in 5 community hospitals served by the Helsinki University Central Hospital (HUCH) in a telestroke network during 2007 to 2009. The characteristics and outcome of telestroke thrombolysis patients are compared with consecutive thrombolysis patients (n = 985) treated at HUCH.
Results:
A total of 106 consecutive telestroke consultations in 2 years led to IV thrombolysis in 61 patients (57.5%). The median NIH Stroke Scale score was 10 (range 3–26), onset to treatment time 120 minutes (interquartile range [IQR] 49), length of consultation 25 minutes (IQR 18) if the consultation led to thrombolysis and 15 minutes (IQR 10) if not (p = 0.032). The rate of symptomatic intracranial bleedings was 6.7% (4/60) according to the National Institute of Neurological Disorders and Stroke definition. Half (28/57) of the thrombolysis patients with complete follow-up data had a favorable outcome (modified Rankin Scale [mRS] 0–2) and a third (17/57) had an excellent recovery (mRS 0–1). Thus the patients treated with thrombolysis based on teleconsultation had similar outcome with those treated at HUCH (mRS 0–2: 49.1% vs 58.1%, p = 0.214 and mRS 0–1: 17/57 [29.4%] vs 352/957 [36.8%], p = 0.289).
Conclusions:
A special feature of the Finnish pilot is the high percentage of consultations leading to thrombolytic treatment with features and results very similar to on-site thrombolysis at the neurologic emergency room of HUCH.
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Supplementary Material
COINVESTIGATORS
Tiina Sairanen, MD, PhD (Department of Neurology, Helsinki University Central Hospital [HUCH], Helsinki, Finland, and Molecular Neurology Research Program, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland, Site investigator); Seppo Soinila, MD, PhD (Department of Neurology, HUCH, Vice Project Leader); Matti Nikkanen, MD (Kuusankoski Regional Hospital, Kuusankoski, Finland, Chief Physician, Site investigator); Kirsi Rantanen, MD (Department of Neurology, HUCH, Site investigator); Satu Mustanoja, MD, PhD (Department of Neurology, HUCH, Site investigator); Markus Färkkilä, MD, PhD (Department of Neurology, HUCH, Head of Department); Ilkka Pieninkeroinen, MD (Kymenlaakso Central Hospital, Kotka, Finland, Chief Physician, Site investigator); Heikki Numminen, MD, PhD (Tampere University Hospital, Tampere, Finland, Chief Physician, Site investigator); Peter Baumann, MD, PhD (Central Hospital of Lapland, Rovaniemi, Finland, Chief Physician, Site investigator); Jussi Valpas, MD (South Carelia Central Hospital, Lappeenranta, Finland, Chief Physician, Site investigator); Tapio Kuha, MD (Länsi-Pohja Central Hospital, Kemi, Finland, Site investigator); Markku Kaste, MD, PhD (Department of Neurology, HUCH, Professor, Advisor); Turgut Tatlisumak, MD, PhD (Department of Neurology, HUCH, Principal investigator, Project Leader), for the Finnish Telestroke Task Force.
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Copyright © 2011 by AAN Enterprises, Inc.
Publication History
Received: June 15, 2010
Accepted: October 25, 2010
Published online: March 2, 2011
Published in print: March 29, 2011
Disclosure
Dr. Sairanen has received speaker honoraria from Boehringer Ingelheim; serves on the editorial board of Experimental & Translational Stroke Medicine; and has received research support from the Helsinki University Central Hospital governmental subsidiary EVO funds for clinical research, the Finnish Medical Association, and the Finnish Medical Foundation. Dr. Soinila has received speaker honoraria from the Finnish Medical Association, the Finnish Medical Society Duodecim, Pfizer Inc., Orion Corporation, UCB, Eli Lilly and Company, and Boehringer Ingelheim; and serves on the editorial board of the Finnish Medical Journal. Dr. Nikkanen has received speaker honoraria from Boehringer Ingelheim. Dr. Rantanen has received speaker honoraria from Boehringer Ingelheim. Dr. Mustanoja has received speaker honoraria from Boehringer Ingelheim. Dr. Färkkilä serves on a scientific advisory board for GlaxoSmithKline and has received funding for travel from Bayer Schering Pharma. Dr. Pieninkeroinen has received speaker honoraria from Boehringer Ingelheim, Sanofi-Aventis, and Bayer Schering Pharma. Dr. Numminen has received funding for travel from UCB, Boehringer Ingelheim, and Orion Corporation. Dr. Baumann has received speaker honoraria from Boehringer Ingelheim. Dr. Valpas and Dr. Kuha report no disclosures. Dr. Kaste has received funding for travel and speaker honoraria from Boehringer Ingelheim, PAION AG, Forest Laboratories, Inc., and Lundbeck Inc.; served as an Associate Editor for Stroke; and serves on the editorial boards of Cerebrovascular Diseases, the International Journal of Stroke, and Avh-Lehti (Journal of Cerebrovascular Disorders). Dr. Tatlisumak serves on scientific advisory boards for Boehringer Ingelheim and Mitsubishi Tanabe Pharma Corporation; has received funding for travel from Boehringer Ingelheim; serves/has served on the editorial board of Stroke, Current Vascular Pharmacology, The Open Pharmacology Journal, Clinics of Turkey, Clinics of Turkey/Neurology, The Open Cardiovascular Medicine Journal, Recent Patents on Biotechnology, Recent Patents on CNS Drug Discovery, Experimental and Translational Stroke Medicine, Stroke Research and Treatment, BMC Journal of Experimental and Translational Stroke Medicine, and Frontiers in Stroke, and was founding Editor-in-chief of Case Reports in Neurology; has filed patents re: Stanniocalcin proteins and nucleic acids and methods based thereon, New therapeutic uses (method to prevent brain edema and reperfusion injury), and Thrombolytic compositions (method to prevent postthrombolytic hemorrhage formation); serves as a consultant for Boehringer Ingelheim, PhotoThera, Mitsubishi Tanabe Pharma Corporation BrainsGate, Schering-Plough Corp., Lundbeck Inc., Sanofi-Aventis, Concentric Medical, Inc.; and receives/has received research support from Boehringer Ingelheim, the Finnish Academy of Sciences, the European Union, Biocentrum Finland, Biocentrum Helsinki, Sigrid Juselius Foundation, Liv och Hälsa, and Maire Taponen Foundation.
Authors
Author Contributions
T.S.: data analysis, literature search, figure and tables preparation, writing the manuscript draft, and biostatistical analyses. S.S.: responsible for the educational/training activities, logistic and administrative support. M.F.: logistic and administrative support. M.K.: logistic and administrative support. T.T.: data analysis, literature search, and co-writing the manuscript draft, logistic and administrative support. Study design, data collection, and data interpretation: all authors. All authors critically revised and approved the final version of the manuscript.
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